Healthcare Provider Details

I. General information

NPI: 1710932967
Provider Name (Legal Business Name): VANESSA D FERRARIO PAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: VANESSA DORENE BEEMAN PA-C

II. Dates (important events)

Enumeration Date: 05/24/2006
Last Update Date: 03/06/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2488 N CALIFORNIA ST ALPINE ORTHOPAEDIC MEDICAL GROUP INC
STOCKTON CA
95204-5508
US

IV. Provider business mailing address

2488 N CALIFORNIA ST ALPINE ORTHOPAEDIC MEDICAL GROUP INC
STOCKTON CA
95204-5508
US

V. Phone/Fax

Practice location:
  • Phone: 209-948-3333
  • Fax: 209-948-2665
Mailing address:
  • Phone: 209-948-3333
  • Fax: 209-948-2665

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: